NEW HORIZONS IN JOINT REPLACEMENT SURGERY
The Era of Computer Navigated Total Knee Replacement
Jhansi Orthopaedic Hospital & research centre, established by Dr D.K. Gupta in 1997 is committed to provide world class facilities in field of orthopaedic to the population of Bundelkhand. On the occasion of World Arthritis Day, for the permanent relief from agonising pain of osteoarthritis knee, Jhansi orthopaedic hospital have now introduced the most advanced technique in field of knee replacement Computer assisted total knee replacement (CAS) also known as computer navigated Total Knee Replacement . Osteo-arthritis (OA) is a chronic progressive degenerative disease of joints. Though it can affect any joint but affection of knee joint is very common, now almost in epidemic form in our elderly society. High incidence of OA in India can be attributed to increased life expectancy, our habits of squatting, sitting cross legged, sedentary life style, obesity etc. Degeneration of articular cartilage (soft padding between the adjoining surfaces of a joint, similar to shockers of a vehicle) triggers inflammation of internal structures of the joint which causes joint pain, muscle spasm deformity and reactive new bone formation (osteophytes), these osteophytes may break and manifest as loose bodies. Clinical features of osteoarthritis of knee include: Pain, swelling & stiffness in and around knee joint, after prolonged standing/sitting, while performing activities of daily living (sitting crossed leg, squatting, stair climbing etc) Abnormal sound while moving the knee joint (crepitus) Deformation of the knee joint Difficulty/ Inability to walk Treatment options available for osteoarthritis of knee joint includes life style modifications, reduction /control of body weight, physiotherapy, drug therapy ( NSAID, SMOAD’s, Vitamin D and calcium supplements , intra-Articular injections etc), some of them are harmful if taken for a long period of time ( NSAID’s). All of these treatments provides symptomatic relief only, not the permanent cure maximum they can only reduce the rate of disease progression but they can’t cure the disease. Usual surgical treatment of osteoarthritis includes: arthroscopic debridement, high tibial osteotomy, stem cell therapy, autologous cartilage transplantation (experimental stage) and total knee replacement (TKR). TKR is the only treatment which removes degenerated joint surfaces, corrects deformity, realigns the soft tissue, bony alignment of hip knee and ankle (line of weight bearing) thus provides permanent relief from the osteoarthritis. There is no need of any immobilization (plaster) following surgery & second day after surgery patient starts to sit on bed with knee hanging outside, and starts walking full weight bearing with a walker, including climbing stairs. Computer assisted surgery (CAS) system also known as Computer navigation is the most modern technique in the field of replacement which works on the same principles as the global positioning system (GPS). In GPS technology for automobile navigation, on board computer collects data point from satellite and uses precise coordinates to give accurate location. Similarly in Computer assisted TKR, computer system with advance infrared cameras captures the patient’s unique hip, knee & ankle anatomy and translates this data to a computer screen, providing the surgeon detailed information on the screen. This helps decision making and enhances the surgeon’s flexibility.
The advantage is that the surgeon has an expended “vision” during surgery. Successful Knee Replacement Surgery involves implanting artificial components with such precision that they align with patient’s hip joint above and ankle joint below accurately so that the patient’s weight can be transferred to the ground efficiently (line of weight bearing) without producing any stress on the bone & joint. Computer navigation helps in doing this by positioning the components precisely with 0.1 degree and 0.1 mm accuracy which naked eye cannot do. In addition, the computer helps to select the precise size of the implant for the patient’s bone, corrects rotational alignments and accurate balance of soft tissue and ligaments around knee. All this allows the joint to flex effectively. For the surgeon Computer navigation works as the third eye, and for the patients, this means better functional outcome and longer implant life.